Shellman Medical LLC
Organization Active NPI Family Medicine Physician · Shellman, GA
NPI 1992548994 · NPPES record last updated Jun 17, 2024
Key facts
- NPI
- 1992548994
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SHELLMAN MEDICAL LLC
- Practice address
- 67 W Railroad St
Shellman, GA 39886-3100 - Phone
- (229) 883-1314
- NPI assigned
- Jun 17, 2024
- Organization subpart
- No
Authorized official
- Name
- Jeremy A Sapp
- Title
- Ceo
- Phone
- (229) 883-1314
Practitioners 8
-
Wael Azer Aziz Azer, D.O.
-
Susan Whatley, ARNP
-
Betsy Diaz, FNP-C
-
Jessica Rose Faust, RN, FNP-C
-
Tiffany Harrell Garland, NP-C
-
Gail Miranda Ricker, APRN
-
Kristie Jo Smith, MSN, RN, FNP
-
Bryan S Green, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2313026 | Shellman Medical LLC | Certificate of waiver | Oct 22, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241024002252 | GA | Part B Supplier - Clinic/Group Practice | 2062945330 |
Receives reassigned benefits from 2 practitioners Practice locations: Shellman, GA; Leesburg, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
67 W Railroad St
Shellman, GA 39886-3100
Mailing address
PO Box 207
Shellman, GA 39886-0207
Other names
- Shellman Medical
Other providers in Shellman, GA
- Hospital Authority of Randolph County
- KJH Medical Services
- Georgie Edwards Langford
- Daphne Dixon Puckett
- Shellman Drug Company
- Shellman Pharmacy
- Shellman Pharmacy
- Southwest Georgia S T E M Charter Inc
All providers in Shellman, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.